title: [Uterine ishtmique transmural hernia: results of its repair on symptoms and fertility].
abstract: OBJECTIVE
  To study the effect of the surgical repair (isthmorraphy) of the large scar dehiscence after cesarean on symptoms and fertility for women who desire pregnancy.
  
  
  METHODS
  In this retrospective study, 14 symptomatic patients, who desire a new pregnancy underwent a surgical repair by laparotomy, laparoscopic or vaginal technique. Five women experienced failure of Assistance Reproductive Technique (IVF or ICSI) for idiopathic secondary infertility. The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy and magnetic resonance imaging.
  
  
  RESULTS
  Symptoms improvement was found in 92% of case. Ten pregnancy (71%) was obtained after surgical repair, 6 spontaneous and 4 after Assistance Reproductive Technique. Among the 5 women initially followed in the reproductive unit, 4 became pregnant, 3 after IVF or ICSI and 1 spontaneous. No operative complication occurred. The subsequent pregnancy was unremarkable with no uterine rupture.
  
  
  CONCLUSIONS
  Large scar defect after cesarean can take shape of a complete absent of the anterior wall of the uterus. No incident has been proved in this condition. There is a lack of data concerning these isthmocele. The experience of hysteroscopic repair cannot be applied to these real large diverticule of the scar cesarean. The results of this study suggest a link between the isthmocele and reversible symptoms after surgery. The first results concerning the subsequent fertility after surgical repair seem interesting
  
  
  CONCLUSIONS
  When a large scare defect (isthmocele) is found in symptomatic woman (pelvic pain, bleeding uterine, infertility), a surgical repair can be proposed, especially for woman who desire a new pregnancy.
authors.affiliation: Service de gynécologie-obstétrique, université Paris-Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France. Electronic address: jeremy.boujenah@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Jeremy
authors.forename: C
authors.initials: C
authors.lastname: Bonneau
authors.forename: E
authors.initials: E
authors.lastname: Guillo
authors.forename: B J
authors.initials: BJ
authors.lastname: Paniel
authors.forename: A
authors.initials: A
authors.lastname: Le Tohic
authors.forename: B
authors.initials: B
authors.lastname: Haddad
authors.forename: P
authors.initials: P
authors.lastname: Madelenat
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D017699:Pelvic Pain; D011247:Pregnancy; D012189:Retrospective Studies; D014592:Uterine Hemorrhage; D014599:Uterus / Q000473:pathology* / Q000601:surgery*
keywords: Cesarean; Césarienne; Defect de la cicatrice; Fertility; Fertilité; Isthmocèle; Isthmorraphie; Isthmorraphy; Réparation chirugical; Scar defect; Surgical repair